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Patient Centered Care

It’s under a month until this assignment is over and I’ll be ready to head back east. I’ve been making a point to do some exploring. Mostly food tours, but they’ve been full of educational and awe inspiring moments. The great Redwoods, lovely Napa and Sonoma, and the historically rich San Francisco Chinatown. I’m planning a tour to Yosemite and a couple other things before I head home to round my experience here out.

In other news, I’ve locked my next assignment down. I’m headed to Plymouth, MA for something a little slower, but no less interesting. Hopefully it’s a friendly group of nurses to work with as well as doctors.

Speaking of physicians, I wanted to touch on something quickly. There is a balance when it comes to patient centered care. Health care originally was more Doctor centered. As in, Doctor knows best and he/she dedicated the treatment and care with little input from the patient. That has changed. Patients are expected to be knowledgeable about and actively participate in their health. They make the decisions but in tandem with their health care providers. Things aren’t done to them options are presented, and the patient helps make the moves that benefit then.

In order to do that, things need to be explained clearly to them. Once they understand, their decisions need to be honored. I won’t force a patient to take pain medication or supplement their baby or walk or get out of bed. I can explain the consequences of their action or lack thereof and hope they understand.

If the patient is educated, then they can make their choices. There has to be a balance and that comes from education, but the doctor cannot be the lord over them.

Here’s an example of disregarding patient centered care: a patient in uncontrolled pain related to labor. The physician pushed for an epidural, but the patient refused. Delivery was rapid and uncontrolled. Later, the nurse asked for something stronger than the NSAID ordered because patient had no relief. It is obvious she is in pain, as is to be expected. The physician refused, stating “she didn’t require anything in labor, why should I give her anything now?”

This is a situation where the doctor felt their wishes were not honored during one part of the patient’s care so it was within boundaries to withhol needed medication for patient comfort.

Wrong.

Educate, not force and then honor the patient’s decision.

Patients are non-compliant regularly and that’s frustrating, but it’s about their care even when they are obviously wrong. A woman has a right to decide her method of pain management when in labor. If you can’t break out of your need to be in total control, maybe it’s time to retire from medicine. Times have changed and we need to always include the patient in their care.

3 thoughts on “Patient Centered Care”

There definitely has to be a balance. I think part of it is the approach also. My post-birth nurses would tell me it was time to take a walk in a way that was pleasant. Even though it felt like an instruction that I had to take, I didn’t feel like I was being forced, if that makes sense.

There are subtle ways to do things. Ways to guide people so they can understand what’s best for their care without forcing them. Some docs haven’t gotten to that point yet. They’re usually the last to change especially the older generation.